Soft food for thought: Why explaining soft diet to your patients is crucial for compliance

August 1, 2019

How to educate your patients about transitioning into their new dentures.

You tell your new denture patients to eat a soft diet and send them on their way. But do they know what that means and which foods are the best for their new prosthesis? Here’s what you need to know about setting the proper expectations about what foods to eat while they adapt to their new dentures.

Marc Wagenseil, CDT, DD, a denturist in Alberta, Canada, and an international lecturer for VITA North America says there is often a misperception in dentistry that once you deliver the dentures, the patient is good to go and they don’t need to be careful.

However, Wagenseil reminds clinicians the central nervous system is not ready to go back to business as usual as far as chewing and eating foods. It needs time to adapt to the change presented by the dentures in the mouth.

“A marathon runner does not buy a new pair of shoes and run a marathon on them immediately. They know to break them in,” Wagenseil says. “Yet we don’t do that in dentistry or with dentures, and then the patient becomes upset or irritated wondering why it hurts.”

Wagenseil explains the central nervous system had a pattern before it had the dentures, and now it will have a new one with the dentures. It will develop a habit with repetition and practice.

Related reading: How to set proper denture expectations

To facilitate this process, Wagenseil wants patients not to eat without consideration. He tells them he wants them to intervene, exercise caution with the pressure with which they bite and reduce the size of their bites. In short, he tells them to take it easy.

However, “taking it easy” means different things to different people, Wagenseil says. It can come down to how a patient interprets “easy” if they are going to have a successful adaptation to the denture.

Soft diets are about learning to chew

You should define a soft diet for patients. Per MedicalNewsToday, the term soft diet describes foods that are easy to chew and swallow and does not include foods whose texture is hard.1 However, this definition leaves a lot to interpretation. Wagenseil says it is essential to take a deeper dive on defining patient expectations for what you mean by “soft diet.”                                                                                  

“Some of the things we know we'd like to say is you want to stay away from the real chewy or more difficult hard things such as nuts,” Wagenseil says, adding for his nut-loving patients, he recommends breaking the nuts with a mallet before they eat them.

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Wagenseil also cautions his patients to be careful with bread. Bread has wheat gluten, and when mixed with saliva, it sticks together. The gelatinous mass that results requires more bite power to get through.

“Thus, the higher the risk of damaging the new appliance or damaging your tissues or bruising them,” Wagenseil says.

Wagenseil knows people are going to eat what they eat, no matter what he says. While he does not get granular with the food on the soft diet, he does want people to go slow and eat smaller pieces.

He also talks with patients to come up with workarounds. For example, if a patient likes raw vegetables, he encourages them to mash them first with a meat tenderizer. If they love Indian food, he explains they need to cut it into smaller pieces.

“You have to give the muscle time to heal and build again, so these are the things to keep in mind when we instruct our denture patients on this,” Wagenseil says.

One of the most important things to do when discussing the soft diet, Wagenseil says, is to see it from the patient’s perspective. Compare it to a time when you received instructions from a healthcare professional for a test or lab work and remember what worked for you.

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“You have to think of yourself as a patient and what did they tell you to do?,” Wagenseil says.

Dr. Shirin Khoynezhad, director of second-year pre-clinical dentistry at the University of Alabama, is a prosthodontist that lectures on denture materials and CAD/CAM dentures. She agrees getting detailed about food is crucial for the new denture patients.

She compares getting dentures to traveling to a new country where everything is new and unpredictable, and when you get there, you are hungry. There is no restaurant you recognize, and no one there speaks your language. If no one told you what to do, you would have to go to every building looking for food and hope there is something appropriate. She says it can feel like being thrown into the ocean without knowing how to swim.

However, if someone familiar with the area told you to go to a particular store (and explained how to get there), and get a certain dish because it their favorite, you’d be prepared. Dr. Khoynezhad says if you get tips ahead of time, you know where to go, and what to do and perhaps most importantly, what to expect.

She does the same with her patients regarding the soft diet. She takes the time to explain and recommend a specific list of foods to help the new denture patient have a better experience transitioning to their new teeth.

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“The more you know, the transition and the adaptation will be easier for you because you know what will happen,” Dr. Khoynezhad says. “You are prepared mentally as well as knowing what the proper foods are.”

She tells patients to expect to take some time to adjust to chewing with the dentures and keeping them in balance. To do that, she recommends graduation of soft foods from the most basic the first week and then building up from there. She recommends mushy vegetables, meats that are tender and moist and pudding. Then, the next week, add in some more advanced soft foods, like lentils, and go from there.

“It’s like practicing. You start at the first level and then go to the second level, and build from there,” Dr. Khoynezhad says. “Give the body time to adapt and eventually add more texture to foods.”

Helping patients learn to chew again

Raymond Choi, DDS, a mini-implant dentist and educator for Glidewell Laboratories, agrees a soft diet is crucial to adapting to a new denture. He defines it as anything you can cut with your fork. He also explains to patients how a denture will not perform the same way as their teeth, they need to slow down, and they need time to learn how to use it before they dive into a regular diet again.

With patients, he uses analogies, comparing the acclimation process for the denture to a person who just lost a leg and has a new prosthesis. The patient with the new leg is not going to sprint on the artificial limb (at least not right away). However, given time, they can run a marathon.

“With a denture, it’s a similar thing. It’s not the same as natural teeth anymore,” Dr. Choi says

Dr. Choi does not have a specific time period he recommends for the soft diet. Instead, he likes to explain to patients that soft food is giving the denture time to settle into the gums and working out any sore spots. As far as when that time is over, Dr. Choi tells patients they will know.

“I will usually say, ‘When the time comes to step it up, you’ll know, and you’ll be more comfortable,’” Dr. Choi explains.

Read more: Improving accessibility with 3D-printed dentures

Dr. Choi also likes to explain to patients how to learn to chew in detail with their new prosthesis. He tells patients to put the food into tubules, then chew on the left and right of the back teeth to stabilize the dentures.

For patients with upper dentures, he tells them not to chew with their upper front teeth. He explains the compression in the soft bone of the premaxilla can accelerate the patient’s bone loss, which will compromise their denture-wearing capacity long-term.

“It took me 20 years to be able to say that because when I was younger, I was afraid patients would say, ‘What do you mean? I pay for this denture, and I can’t even eat?’” Dr. Choi says, laughing. “But now I’m older, I have some gray in my hair, and I can say whatever I want, and they listen.”

Dr. Choi also recommends clinicians assess the alveolar ridge of the oral cavity before dispensing advice. Patients with a tall wide ridge can chew things much differently than patients whose ridge has flattened out. He also recommends with the latter group clinicians use flatter teeth in the denture, so they don’t catch as much.

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VeryWellHealth.com has some additional tips for you to cover for patients eating with dentures:2

  • Have patients use their lips to test the temperature of foods. The insulating quality of dentures might not give patients an accurate read of temperature at first.

  • Set their expectations about discomfort. At first, the tongue and other muscles in the mouth might be sore from the new ways they are chewing. Remind them it’s normal and will decrease with time. However, advise patients to call if they find the denture is causing sores that don’t heal or if the muscle pain continues past the first week or so.

  • Have drinks available when you eat. Remind patients to drink water with their meals. It will not only wash away sugars that can damage the denture, but it will also keep grains from sticking to their teeth, which can cause problems.

Adapting to dentures is a process. Wagenseil compares the soft diet phase of eating with dentures to physical therapy. You go slow in physical therapy, and you do not overdo it because that will set you back in the healing process.

Wagenseil wants people to err on the side of caution when they’re first getting accustomed to dentures, and the clinician should instill that caution. He wants the patient to understand they are slowly building their eating up again with the new appliance.

“You must learn to crawl to learn to walk to learn to run,” Wagenseil says.

 

References

1. Olsen, RD, LD, ACSM, EP-C, Natalie. “What are the soft foods and mechanical soft food diets?” www.medicalnewstoday.com. 26 March 2018. Web. 11 July 2019. < https://www.medicalnewstoday.com/articles/321331.php>.

2. Lehman, Shereen. “Tips for Eating With New Dentures.” Verywellhealth.com. 5 July 2019. Web. 11 July 2019. < https://www.verywellhealth.com/tips-for-eating-with-new-dentures-2507129>.